Improving HIV care continuum outcomes among formerly incarcerated individuals through critical time legal interventions

通过关键时刻的法律干预改善前被监禁者的艾滋病毒护理连续结果

• 批准号: 10819889
• 负责人: Steven A Safren
• 金额: $ 23.08万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10819889
• 关键词: Address; Advocate; Affect; Asthma; Behavioral; COVID-19; Caring; Case Management; Case Manager; Clinic; Clinical; Communication; Communities; Community Health; Conflict (Psychology); Consolidated Framework for Implementation Research; Continuity of Patient Care; Data; Development; Diabetes Mellitus; Discrimination; Domestic Violence; Emotional; Employment; Ensure; Epidemic; Evidence based intervention; Fatigue; Florida; HIV; Health; Health Services; Healthcare; Healthcare Systems; Heart Diseases; Hispanic-serving Institution; Homelessness; Housing; Hypertension; Imprisonment; Individual; Intervention; Lead; Legal; Legal Intervention; Manuals; Medical; Mental Health; Neighborhood Health Center; Nonprofit Organizations; Outcome; Pain; Patients; Perceived quality of life; Pharmaceutical Preparations; Protocols documentation; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recovery; Reporting; Research Personnel; Risk; Risk Factors; Safety; Services; Social Justice; Social Work; Structural Racism; Structure; Testing; Time; Training; Translations; Universities; Viral; Work; Workplace; acceptability and feasibility; barrier to care; care outcomes; clinical care; collaborative environment; court; design; enhancing factor; evidence base; experience; food security; global health; health care delivery; health equity; health inequalities; implementation framework; implementation strategy; improved; improved outcome; innovation; marginalization; medically underserved; medically underserved population; medication compliance; meetings; migration; operation; patient-clinician communication; physical conditioning; pilot test; pilot trial; prevent; primary care provider; programs; protocol development; psychosocial; research study; service providers; social; social stigma; substance use; underserved community

Project Summary. Formerly incarcerated individuals are impacted by health-harming legal needs and risks, including lack of access to HIV care, unsafe housing safety, unstable employment, and other issues that often disrupt HIV care. Providing access to legal services can address barriers to HIV care and improve HIV care continuum outcomes for formerly incarcerated individuals. The proposed study, led by the University of Central Florida (Hispanic Serving Institution), together with the University of Miami, and Hope and Help Inc., aims to pilot test a comprehensive critical-time intervention medical legal partnership (CTI-MLP) approach to optimize timely HIV linkage, retention and viral suppression among formerly incarcerated individuals. MLPs have been used by social justice-oriented medical, health, social, and legal service practices to identify and address health-harming legal needs and risks that create barriers to treatment, care, and recovery for several health conditions. MLPs offer an integrated structural intervention that could improve HIV care continuum and psychosocial outcomes among formerly incarcerated individuals. Our CTI-MLP intervention package consists of: 1) training for all MLP staff (clinical, social and behavioral services, and legal) on HIV continuum of care, health-harming legal needs and risks impacting formerly incarcerated individuals, and MLP structure and operations to ensure that an integrated and collaborative environment is established from the earliest stages of the program; 2) training for case managers and court advocate on the legal continuum of care; 3) embedding of legal expertise within regularized case management team meetings; 4) co-locating legal services in health care agencies through MLP inter-organizational partnership; and 5) tailoring and implementing organizational best-practices in communication and information-sharing protocols among providers within MLP, anchored in patient autonomy and choice. In year 1, we will engage a local community advisory board, scientific advisory board, and legal expert panel to finalize protocols and the Medical Legal Partnership Training Manual. In year 2, we will implement the training and pilot test a CTI-MLP initiative with formerly incarcerated individuals living with HIV (n=100). Over a 6-month period, the team will collect (1) patients' health and functioning, including overall physical health, mental health, social health, pain, fatigue, and overall perceived quality of life; (2) data on legal needs and risk factors; (3) patient HIV care clinical outcomes; and (4) clinic-level indicators, including provider-patient communication and readiness for continued implementation and sustainability. The study will be guided by Reach, Effectiveness, Adoption, Implementation, and Maintenance and Consolidated Framework for Implementation Research frameworks. Active engagement will ensure the effective translation and dissemination of our findings into practice. Completion this project will result in an innovative, evidence-based, community driven structural intervention to improve HIV care continuum outcomes among formerly incarcerated individuals.

项目摘要。以前被监禁的人受到健康的法律需求和风险的影响， 包括无法获得艾滋病毒护理，不安全的住房安全，不稳定的就业以及其他经常的问题 破坏艾滋病毒护理。提供获得法律服务的机会可以解决艾滋病毒护理的障碍并改善艾滋病毒护理 以前被监禁的个体的连续性结果。由中央大学领导的拟议研究 佛罗里达州（西班牙裔服务机构）与迈阿密大学和希望与帮助公司一起试行 测试全面的关键时间干预医疗法律合作伙伴关系（CTI-MLP）方法以优化及时 以前被监禁的个体中的艾滋病毒联系，保留和病毒抑制。 MLP已被使用 面向社会正义的医疗，健康，社会和法律服务实践，以识别和解决健康损害 法律需求和风险在几种健康状况下为治疗，护理和康复造成障碍。 MLP 提供综合的结构干预措施，可以改善HIV护理连续性和社会心理结局 在以前被监禁的个体中。我们的CTI-MLP干预软件包包括：1）所有MLP培训 艾滋病毒连续体的员工（临床，社会和行为服务以及法律），健康损害法律需求 以及影响以前被监禁的个人以及MLP结构和操作的风险，以确保 从计划的最早阶段建立了集成和协作的环境； 2）培训 案件经理和法院倡导者关于法律护理的连续性； 3）嵌入法律专业知识 正规案件管理团队会议； 4）通过MLP在医疗保健机构中共同关注法律服务 组织间合作伙伴关系； 5）裁缝和实施组织最佳实践 MLP中提供商之间的沟通和信息共享协议，以患者自主权为基础 和选择。在第一年，我们将与当地社区顾问委员会，科学顾问委员会和法律互动 专家小组最终确定协议和《医疗法律合伙培训手册》。在第二年，我们将实施 培训和试验测试CTI-MLP计划与以前被监禁的艾滋病毒（n = 100）的人。超过 一个为期6个月的时期，该团队将收集（1）患者的健康和功能，包括整体身体健康， 心理健康，社会健康，疼痛，疲劳以及整体感知的生活质量； （2）有关法律需求和风险的数据 因素； （3）患者艾滋病毒护理临床结果； （4）诊所级指标，包括提供者患者 沟通和准备持续实施和可持续性。该研究将由 覆盖，有效性，采用，实施，维护和合并框架 实施研究框架。积极参与将确保有效的翻译和 将我们的发现传播到实践中。完成此项目将导致创新的，循证的， 社区驱动的结构干预以改善以前被监禁的艾滋病毒护理连续性结果 个人。

项目成果

Cognitive Performance, as well as Depression, Alcohol Use, and Gender, predict Anti-Retroviral Therapy Adherence in a South African Cohort of People with HIV and Comorbid Major Depressive Disorder.

• DOI: 10.1007/s10461-023-03992-7
• 发表时间: 2023-08
• 期刊: AIDS AND BEHAVIOR
• 影响因子: 4.4
• 作者: Dreyer, Anna J.;Nightingale, Sam;Andersen, Lena S.;Lee, Jasper S.;Gouse, Hetta;Safren, Steven A.;O'Cleirigh, Conall;Thomas, Kevin G. F.;Joska, John
• 通讯作者: Joska, John